What Constitutes ‘Extraordinary Care’?

Pregnant Woman’s Brain-Dead Diagnosis Renews Abortion Debate

FORT WORTH, Texas — A hospital room in the city of Fort Worth, Texas, has become the newest focal point in the national abortion debate.

In John Peter Smith Hospital lies the body of 33-year-old Marlise Muñoz, who is reportedly brain-dead, after having suffered what seemed to be a blood clot in her lungs last November. Her bodily functions are being sustained on a ventilator, however, because Muñoz is now 20 weeks pregnant, and hospital officials are interpreting Texas law to require that Muñoz not be disconnected from life support until the viability of her baby can be determined.

The case is causing a national debate about when human life begins, a woman’s "right to choose" and other questions that lie at the heart of the abortion question.

Muñoz’s husband and parents are seeking legal action against the hospital, charging that Muñoz made clear that she would never want to be dependent on a ventilator and saying that her wishes are being ignored.

Many details of the case are unknown, either because the information is not being released or because it is, for now, impossible to ascertain (for example, it is not certain if the baby might have suffered complications during the same clotting episode that caused Muñoz to lose brain function).

Still, from the standpoint of Catholic morals, certain principles are clear, says E. Christian Brugger, the J. Francis Cardinal Stafford Chair of moral theology at St. John Vianney Theological Seminary.

"If she’s brain-dead — and that can be verified by a number of tests — and if brain death is a reliable criterion for human death, which in my mind is a serious question, then [this is a case of] merely a corpse that is having blood pumped through the circulatory system and oxygen pumped through the lungs and being assimilated into the body. The body is being made to look alive by the assistance of medical technology, but there is no soul."

If indeed Muñoz is brain-dead, the woman is gone from her body, he emphasized — presuming, that is, that brain death is a reliable indicator of human death, an issue under debate in the case of Jahi McMath, the 13-year-old girl currently being kept alive after being diagnosed as brain-dead by a hospital following tonsillectomy surgery.

Muñoz’s baby, however, is still quite alive. Brugger explained to the Register that the classic moral criteria for evaluating medical decisions thus come into play, primarily with the emphasis on determining what is in the best interests of the baby.

"The needs of the woman, if she’s in fact dead, have passed," Brugger stated. "She no longer has any needs. And, therefore, decisions should be made based upon what’s in the best interest of the baby."

"That’s not to say that persons while they are alive cannot make decisions about how their mortal remains should be dealt with," he continued.

But there remains another patient, Brugger stressed, "the baby. And questions should be asked based upon the principles of ordinary and extraordinary care based upon the baby’s needs."

"So we ask, ‘Are these medical procedures futile, the first question of determining if something is ordinary or extraordinary’?" That is to say, he explained, "do they offer reasonable hope of benefit for the baby?"

Brugger noted past cases of similar situations, in which a mother’s bodily functions have been sustained to bring babies to viability. "Of course, you’d have to have a reliable diagnosis in this particular case," he continued. "You have to be free of reasonable doubt that the baby could live in order to classify the ventilator as futile medical intervention."

Next, is the procedure gravely burdensome, primarily to the baby? Secondarily, is it burdensome to the family and the community? Brugger noted that the ventilator is probably causing negligible burden for the baby. "It seems to me that a baby at 20 weeks whose mother’s body is being kept alive, or at least being kept running, would not experience much distress at all," he said.

Still, he was careful to avoid oversimplifying the case.

"Again, it depends on the medical diagnosis for the baby and the baby’s life," Brugger explained. In contrast, if the baby were much younger, with only a few weeks of gestation and requiring three or four months of life support and with much less possibility of survival, then the balance of what is "ordinary" and "extraordinary" might change.

Brugger also offered commentary on the way Muñoz’s case is being analyzed publicly with an "abortion mentality."

"It doesn’t seem straightforward in many persons’ minds that what is at stake, or one of the things at stake, is the question of whether we have a corpse gestating a baby or a living human being gestating her baby," he said. "Why is that relevant? Well, if it’s a living human being gestating a baby, a woman gestating an unborn baby, and a woman’s right to choose is deified the way we’ve deified it in our community, and if she clearly has said — and it appears that it’s pretty unambiguous that she’s said — ‘I don’t want to be kept on life support,’ then you’re violating the woman’s ‘right to autonomy’ by keeping her on life support for the sake of the baby."

Continued Brugger, "People say, ‘She has a right not to have to be on life support irrespective of whether she’s pregnant or not, and this Texas law is violating her right to self-determination.’"

But in contrast to this analysis by those who accept the moral arguments advanced by abortion proponents, the faithful Catholic community doesn’t see a lot of controversy, Brugger said, since the crucial question in play is if it’s possible for the baby to live.

"I really am not sure why the husband and the family, if they really believe their wife and daughter is dead, are not bending over backwards to save the life of the baby," Brugger reflected. "Why would they not want the baby to be kept alive? Mom is already dead. They can respect the corpse, they are not going to desecrate the corpse, and the baby could live — and we just need two or three weeks in order for that to be the case."

Summarized Brugger, "So arguing for the autonomy of the woman while she was alive to make decisions over how her mortal remains would be treated seems to be very odd."

Comments

The National Catholic Bioethics Center in Philadelphia has wonderful resources for medical professionals and lay people to help make ethical medical end of life decisions.

That being said-my understanding with end of life care is if treatment is burdensome to the patient, family and community, is futile and extraordinary, treatment can be omitted. In the case of a person already declared dead, this would seem to be very burdensome to extend unimaginable suffering to the family keeping this woman alive.

The other item to discuss is Who is going to pay for all of this ? Few nursing homes take vent patients, let alone vent dependent, pregnant ,legally declared dead patients. The hospital will not keep this lady forever…is her husband supposed to become burdened with insurmountable monetary debt and unable to care for himself and his living child ? These seem to fit the criterion for burdensome futile endeavors. Science has surpassed our humanity it seems and now the Texas law has made an unbearable situation more difficult. Now the baby is 20 weeks old but will have to endure 4-5 weeks in utero keeping a dead mother on a machine so it can have even a chance at life…but is this reasonable ordinary care or should we let nature take it’s course and allow the baby a dignified death and allow this poor mother to finally be laid to rest instead of becoming a science experiment. Prayer is needed all around and I hope a Catholic ethicist will teach us on this complex subject according to Catholic teaching. Thank you.

Posted by Kathy on Sunday, Jan 26, 2014 11:07 PM (EDT):

I am an RN Trauma Care-very pro-life. Manny on these posts wonder why the family is not bending over backward to save the baby. Perhaps because they have been informed that if the mother is kept alive 3 MORE weeks on top of the 8 already after death, the baby born at 23 weeks has a survival rate of 20-35%- If mom is kept alive 4 MORE weeks on top of 8 since death and the child is born at 24-25 weeks the survival rate is 50-70% after enduring rigorous painful ICU care. Can we expect families to endure visiting a dead family member for 12 weeks- that truly is burdensome, extraordinary & most likely futile care. Just imagine going to a funeral home day after day for 12 weeks visiting a corpse- it is no different. This is horrifying to keep bodies alive at all costs rather than allow nature to take it’s course.
What will be next keeping alive dead bodies to store organs for donation ?

This is a tragic situation, extremely difficult ethically to make decisions for all concerned. As Catholics our hope is in the resurrection and life, Under any “normal” circumstances this dear child would be in God’s presence & not have become a scientific experiment on earth. The child’s death would be a natural unintended effect of his mothers death far different from a woman who is alive yet unconscious and her body systems are operating on their own.
I wonder if there is even any scientific literature on a case such as this ?

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